Determinants of persistent post-COVID-19 symptoms: value of a novel COVID-19 symptom score

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Abstract

Background

Being a newly emerging disease, little is known about its long-lasting post-COVID-19 consequences. The aim of this work is to assess the frequency, patterns, and determinants of persistent post-COVID-19 symptoms and to evaluate the value of a proposed novel COVID-19 symptom score. Patients with confirmed COVID-19 in a hospital-based registry were included in a cross-sectional study (the hospitals including Assiut University Hospital, Assiut Chest Hospital, Aswan University Hospital, and Aswan Specialized Hospital). The patient demographics, comorbid disorders, the mean duration since the onset of the symptoms, history of hospital or ICU admittance, and the treatment taken during the acute state, as well as symptom score before and after convalescence, were recorded.

Results

The most frequent constitutional and neurological symptoms were myalgia (60.0%), arthralgia (57.2%), restriction of daily activities (57.0%), and sleeping troubles (50.9%), followed by anorexia (42.6%), chest pain (32.6%), gastritis (32.3%), cough (29.3%), and dyspnea (29.1%). The mean total score of acute stage symptoms was 31.0 ± 16.3 while post-COVID 19 symptom score was 13.1 ± 12.6 ( P < 0.001). The main determinants of the persistent post-COVID-19 symptoms were the need for oxygen therapy ( P < 0.001), pre-existing hypertension ( P = 0.039), chronic pulmonary disorders ( P = 0.012), and any chronic comorbidity ( P = 0.004). There was a correlation between the symptom score during the acute attack and post-COVID-19 stage ( P < 0.001, r = 0.67). The acute phase score had 83.5% sensitivity and 73.3% specificity for the cutoff point > 18 to predict occurrence of post-COVID-19 symptoms.

Conclusions

COVID-19 can present with a diverse spectrum of long-term post-COVID-19 symptoms. Increased acute phase symptom severity and COVID-19 symptom score > 18 together with the presence of any comorbid diseases increase the risk for persistent post-COVID-19 manifestations and severity.

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Most cited references 40

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The trinity of COVID-19: immunity, inflammation and intervention

Matthew Tay, Chek Meng Poh, Laurent Rénia … (2020)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Alongside investigations into the virology of SARS-CoV-2, understanding the fundamental physiological and immunological processes underlying the clinical manifestations of COVID-19 is vital for the identification and rational design of effective therapies. Here, we provide an overview of the pathophysiology of SARS-CoV-2 infection. We describe the interaction of SARS-CoV-2 with the immune system and the subsequent contribution of dysfunctional immune responses to disease progression. From nascent reports describing SARS-CoV-2, we make inferences on the basis of the parallel pathophysiological and immunological features of the other human coronaviruses targeting the lower respiratory tract — severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Finally, we highlight the implications of these approaches for potential therapeutic interventions that target viral infection and/or immunoregulation.

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Persistent Symptoms in Patients After Acute COVID-19

Angelo Carfì, Roberto Bernabei, Francesco Landi (2020)

This case series describes COVID-19 symptoms persisting a mean of 60 days after onset among Italian patients previously discharged from COVID-19 hospitalization.

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Covid-19 in Critically Ill Patients in the Seattle Region — Case Series

Pavan K. Bhatraju, Bijan J Ghassemieh, Michelle Nichols … (2020)

Abstract Background Community transmission of coronavirus 2019 (Covid-19) was detected in the state of Washington in February 2020. Methods We identified patients from nine Seattle-area hospitals who were admitted to the intensive care unit (ICU) with confirmed infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Clinical data were obtained through review of medical records. The data reported here are those available through March 23, 2020. Each patient had at least 14 days of follow-up. Results We identified 24 patients with confirmed Covid-19. The mean (±SD) age of the patients was 64±18 years, 63% were men, and symptoms began 7±4 days before admission. The most common symptoms were cough and shortness of breath; 50% of patients had fever on admission, and 58% had diabetes mellitus. All the patients were admitted for hypoxemic respiratory failure; 75% (18 patients) needed mechanical ventilation. Most of the patients (17) also had hypotension and needed vasopressors. No patient tested positive for influenza A, influenza B, or other respiratory viruses. Half the patients (12) died between ICU day 1 and day 18, including 4 patients who had a do-not-resuscitate order on admission. Of the 12 surviving patients, 5 were discharged home, 4 were discharged from the ICU but remained in the hospital, and 3 continued to receive mechanical ventilation in the ICU. Conclusions During the first 3 weeks of the Covid-19 outbreak in the Seattle area, the most common reasons for admission to the ICU were hypoxemic respiratory failure leading to mechanical ventilation, hypotension requiring vasopressor treatment, or both. Mortality among these critically ill patients was high. (Funded by the National Institutes of Health.)

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Author and article information

Contributors

Islam Galal: Islamgalal76@yahoo.com , islamgalal@aswu.edu.eg

Aliae A. R. Mohamed Hussein:

ORCID: https://orcid.org/0000-0002-7111-2195

aliaehussein@gmail.com , aliaehussein@aun.edu.eg

Mariam T. Amin:

ORCID: https://orcid.org/0000-0003-0089-9418

mariam.amin015@gmail.com

Mahmoud M. Saad: Mahmoud.20134331@med.au.edu.eg

Hossam Eldeen E. Zayan: Heez1518@yahoo.com

Mustafa Z. Abdelsayed: Moustafa.13235354@med.aun.edu.eg

Mohamed M. Moustafa: Mohamedmamdouh15794@gmail.com

Abdel Rahman Ezzat: Abdelrahman.ezzat2013@gmail.com

Radwa E. D. Helmy: Radwaemad100@gmail.com

Howida K. Abd_Elaal: drhouida_81@yahoo.com

Nasrallah A. Al Massry: nasrallah.almassri98@gmail.com

Mohamed A. Soliman: drsoliman85@yahoo.com

Asmaa M. Ismail: a_esmaildr@yahoo.com

Karima M. S. Kholief: karema55@yahoo.com

Enas Fathy: enas.fathy@aswu.edu.eg

Maiada K. Hashem: maiada.hashem@gmail.com

Journal

Journal ID (iso-abbrev): Egypt J Bronchol

Title: The Egyptian Journal of Bronchology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 1687-8426

ISSN (Electronic): 2314-8551

Publication date (Electronic): 5 February 2021

Publication date PMC-release: 5 February 2021

Publication date (Print): 2021

Volume: 15

Issue: 1

Electronic Location Identifier: 10

Affiliations

[1 ]GRID grid.417764.7, ISNI 0000 0004 4699 3028, Aswan Faculty of Medicine, , Aswan University, ; Aswan, Egypt

[2 ]GRID grid.411437.4, ISNI 0000 0004 0621 6144, Chest Department, , Assiut University Hospitals, ; Assiut, 71515 Egypt

[3 ]GRID grid.252487.e, ISNI 0000 0000 8632 679X, Assiut Faculty of Medicine, , Assiut University, ; Assiut, Egypt

[4 ]GRID grid.411437.4, ISNI 0000 0004 0621 6144, Gastroenterology and infectious disease Department, Assiut University Hospitals, ; Assiut, Egypt

[5 ]GRID grid.411437.4, ISNI 0000 0004 0621 6144, Assiut University Hospitals, ; Assiut, Egypt

[6 ]GRID grid.252487.e, ISNI 0000 0000 8632 679X, Medical Pharmacy, , Assiut University, ; Assiut, Egypt

[7 ]GRID grid.252487.e, ISNI 0000 0000 8632 679X, Assiut University, ; Assiut, Egypt

[8 ]GRID grid.16662.35, ISNI 0000 0001 2298 706X, Al Quds University, Alazhar University, Gaza Branch, ; Gaza, Palestine

[9 ]GRID grid.417764.7, ISNI 0000 0004 4699 3028, Department of Cardiovascular Medicine, Faculty of Medicine, , Aswan University, ; Aswan, Egypt

[10 ]GRID grid.411437.4, ISNI 0000 0004 0621 6144, Chest Department, Assiut Faculty of Medicine, , Assiut University Hospitals, ; Assiut, Egypt

Author information

Aliae A. R. Mohamed Hussein https://orcid.org/0000-0002-7111-2195

Mariam T. Amin https://orcid.org/0000-0003-0089-9418

Article

Publisher ID: 49

DOI: 10.1186/s43168-020-00049-4

PMC ID: 7863043

SO-VID: 66c3bb30-8ece-4ff1-998c-52ec25604b20

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 4 November 2020

Date accepted : 23 December 2020

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Keywords: post-covid-19 symptoms,symptom score,covid-19 symptom score,comorbidities,persistent symptoms

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Keywords: post-covid-19 symptoms, symptom score, covid-19 symptom score, comorbidities, persistent symptoms

Determinants of persistent post-COVID-19 symptoms: value of a novel COVID-19 symptom score

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Novel Coronavirus Disease COVID-19

Most cited references 40

The trinity of COVID-19: immunity, inflammation and intervention

Persistent Symptoms in Patients After Acute COVID-19

Covid-19 in Critically Ill Patients in the Seattle Region — Case Series

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